Spinal manipulation has been practiced for thousands of years: It was depicted in Egyptian hieroglyphic forms, and Hippocrates and Aristotle discussed the importance of spinal care in early Greek times.
In America, spinal manipulation was introduced in the 1800s by two early practitioners. Andrew Taylor Still, a physician who practiced medicine in Kansas and Missouri at the time, became disillusioned with the medical profession of that time and went about looking for a better form of medical treatment. In 1874, he decided therapeutic spinal manipulation was a superior treatment. His philosophy was that structure and function were interrelated and manipulation could balance the structure, thereby improving bodily function and self-healing
In 1895, D.D. Palmer, who was not a physician, performed his first cervical manipulation on a deaf janitor whose hearing was restored. Palmer started the first chiropractic school in Davenport, Iowa. His theory was that spinal manipulation could balance subluxation (imbalance) of the vertebrae, which improved the flow of a supernatural healing force. He felt that 95% of all diseases could be attributed to misaligned vertebra.
Over the next couple decades, both chiropractic and osteopathic schools were opened across the country. Palmer rejected combining chiropractic with other healing procedures, which led to a schism of chiropractic philosophy that still exists today: those chiropractors practicing manual manipulation by hand only, and those chiropractors who incorporate a wellness philosophy that includes natural remedies, exercises and improved nutrition.
Although there is still the need for studies to prove exactly how spinal manipulation relieves back and neck pain and how it might help improve health, overall there have been many studies that have shown that spinal manipulation does help reduce acute and chronic back pain more than a placebo effect. In fact, in 2007, the American College of Physicians reviewed all scientific literature to produce guidelines for treating low back pain. One of the nonpharmacologic recommendations was the use of spinal manipulation. The recommendation did not stipulate whether the spinal manipulation was chiropractic, osteopathic or from a licensed therapist. I
Which leads to the question: Is there a difference in spinal manipulation between practitioners?
In the osteopathic profession, there are several spinal manipulation techniques. The spinal manipulation that we believe Still used is now called the Still Technique. It involves using leverage on the spine by applying mild force through the arms, legs and even the head. Other techniques have evolved through the years, discovered by practicing osteopathic physicians who then taught others at school and professional meetings.
In the past, the spinal manipulation a practitioner used was largely influenced by the school the practitioner attended and the staff who taught him or her. In the last few years, the osteopathic schools have been trying to standardize the techniques taught to all students. The manipulation used by practitioners is still likely to be different as it depends on the techniques learned in osteopathic schools, the courses attended by the individual physician and even the physique of the physician. A smaller physician is likely to use different techniques than a larger physician because forces applied are likely to be different. All D.O. physicians are taught spinal manipulation in osteopathic medical schools, but the majority do not practice it. Reasons include residency programs where manipulation is not practiced, specialties that manipulation is less well-suited for or just a lack of interest in using it.
Osteopathic manipulation is typically used for back and neck pain but can also be used to treat a variety of other problems. Visceral manipulation can be used for gastrointestinal problems. Cranial manipulation is used on newborn infants for correcting severe cranial molding from delivery and for those who have trouble breast-feeding.
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Several studies have looked at what kind of individual seeks chiropractic care and what kind of care a chiropractor might give to that patient. Studies have shown approximately 50% of individuals seeking a chiropractor for the first time have low back pain, approximately 23% have neck pain and approximately 10% have extremity pain. About 7.5% were looking for wellness. Chiropractic treatment included nearly 80% spinal manipulation, 35% soft-tissue therapy, 31% formal education, 31% nutritional supplements and 26% exercise instruction. Research also suggests 23% of patients received activator treatment, a spring-loaded device used for vertebral adjustments.
Other treatments included manual traction, drop-table treatment, heat/cold treatment, ultrasound, electrical stimulation and acupuncture. Unlike DOs, chiropractors cannot prescribe medication. Chiropractic spinal manipulation typically is high velocity, low amplitude, a direct technique that frequently elicits a “pop” of the vertebral joint.
Some physical therapists use manual therapy as well. They may have learned techniques from other therapists or attended chiropractic or osteopathic conferences. There are even a few MDs who attend these conferences, so they can use these techniques when appropriate too.
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